Evaluation of the diagnostic ability of the Fränkel manoeuvre to detect the contributing jaw in angle class II division 1 malocclusion.

BACKGROUND: A correct diagnosis of patients with an Angle Class II malocclusion is needed to guide treatment decisions toward the contributing jaw and to achieve better treatment outcomes. The aim of the study is to evaluate the diagnostic potential of the Fränkel manoeuvre (FM) for detecting the components determining sagittal discrepancy in Angle Class II division 1. MATERIALS AND METHODS: Anonymous questionnaires containing photographs were distributed totwo groups: general practitioner (GP) dentists and orthodontists. The level of the patient's profile aesthetics before (T0) and after (T1) the manoeuvre was determined using a 100 mm visual analog scale, and the 'profile improvement' score was defined as T1 minus T0. The diagnostic ability of the FM was calculated by comparison with lateral cephalometry as a reference standard using receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 102 respondents participated in the survey; 40 were orthodontists, and 62 were GP dentists. According to the post-FM images, the "profile improvement" score (T1-T0) was significantly greater in patients with mandibular retrusion than in those with maxillary protrusion (p < 0.05). The predictive power of FM, coinciding with the area under the ROC curve, was 0.62 for GPs and 0.78 for orthodontists. CONCLUSIONS: The FM method is a useful and accurate tool for diagnosing skeletal Angle Class II malocclusion etiology (mandibular retrusion or maxillary protrusion), especially when used by orthodontists.

Well-Being of Orthodontic Patients Wearing Orthodontic Appliances.

Background and Objectives: Orthodontic appliances may cause discomfort for patients. This could influence the person's psychological well-being. The aim of this study was to examine the psychological health of patients wearing orthodontic appliances. It is important to analyze the well-being of patients during orthodontic treatment because it is started in a young age and it may affect one's psychological health. Therefore, for doctors and patients, it is important to understand and take every aspect of the treatment into consideration when deciding when to start the treatment and what appliance to choose. Materials and Methods: A total of 339 patients filled out an anonymous questionnaire. They were divided into four groups according to their age and type of appliance. The main reasons to seek treatment were crooked teeth and a bad bite. There was a statistically significant difference between women and men as women sought treatment because of crooked teeth; meanwhile, men indicated bad bite as their main reason for seeking treatment. Results: A total of 48.7% of subjects noted that they were feeling good during treatment; however, 4% of all patients noted that they were feeling bad. A total of 45% of subjects stated that they felt unhappy at least sometimes. A total of 43% of subjects felt stress. Conclusions: Even though patients indicated various negative aspects on their well-being during treatment, for the majority of the subjects, the end results significantly increased their psychological well-being.

Genetic and environmental impact on variation in the palatal dimensions in permanent dentition: a twin study.

The objective of this study was to assess the relative contributions of genetic and environmental factors to variation in palatal parameters in twins with completed maxillary growth. The subjects of this study comprised digital dental casts of 50 monozygotic and 35 dizygotic twin pairs. The subjects' average age was 17.95 ± 2.83 years. Zygosity determination was carried out using 15 specific DNA markers and an amel fragment of the amelogenin gene. The interdental distances were measured between selected dental landmarks at the occlusal and gingival planes. The palatal height, surface area and volume were measured between the gingival plane and the midpalate suture. High heritability estimates were observed for all transverse intra-arch measurements. The palate height (a2 = 0.8), dental arch width in the molar area (a2 = 0.86), palatal surface area (a2 = 0.61) and palate volume (a2 = 0.69) were under strong additive genetic control. Moderate genetic dominance was observed for dental arch widths at the gingival line in the canine (d2 = 0.5) and premolar regions (d2 = 0.78-0.81). Sexual dimorphism was shown, with males exhibiting a greater arch width, palate surface area and volume than females (p < 0.01). The majority of palate parameters variation in twins was controlled by genetic effects, and most were highly heritable.

Correlation Between Third Molar Mineralization and Midpalatal Suture Maturity: A Cone Beam Computed Tomography Study.

BACKGROUND Midpalatal suture ossification varies in patients of different ages, which can lead to making inaccurate presumptions when considering effective treatment timing based on chronological age. Chronological age provides only general information, whereas dental development correlates with skeletal growth, which suggests that tooth mineralization could be considered to be a precise criterion for determining the midpalatal suture's maturity. The present study was conducted to investigate the association between third-molar mineralization and midpalatal suture's maturation stages using cone-beam computed tomography (CBCT) images. MATERIAL AND METHODS The study involved 97 CBCT images of patients aged 8-37 years with normal growth and development. Subjects with cleft lip and palate, caries treatment, or present cavities in the third molars were not included in the study. The stages of midpalatal suture ossification were evaluated according to the protocol suggested by Angelieri et al, and the third-molar mineralization degree was measured by the Demirjian index. Statistical analysis was performed to evaluate correlations between the variables. RESULTS Patients with advanced third-molar mineralization stages were found to have greater midpalatal suture maturity. A statistically significant positive correlation was found between the stages of third-molar mineralization and midpalatal suture maturation (R=0.814, P<0.01). Third-molar development was also found to be associated with chronological age (R=0.883, P<0.01). CONCLUSIONS A measure of third-molar mineralization does not allow for accurate determination of the midpalatal suture maturation stage.

Heritability of cephalometric variables of airway morphology in twins with completed active growth.

BACKGROUND: The interplay between genetic and environmental impacts on dental and facial morphology has been widely analyzed, but little is known about their relative contributions to airway morphology. The aim of this study was to evaluate the genetic and environmental influences on the cephalometric variables of airway morphology in a group of postpubertal twins with completed craniofacial growth. MATERIALS AND METHODS: The materials comprised lateral head cephalograms of 94 pairs of twins (50 monozygotic, 44 dizygotic) with completed craniofacial growth. Zygosity was determined using 15 specific DNA markers. The computerized cephalometric analysis included 22 craniofacial, hyoideal, pharyngeal structural linear and angular variables. Genetic analysis and heritability estimation were performed using maximum likelihood genetic structural equation modeling (GSEM). Principal component analysis (PCA) was used to assess the correlations between cephalometric measurement variables. RESULTS: Upper airway dimensions showed moderate to high genetic determination (SPPW-SPP and U-MPW: a2 = 0.64 and 0.5, respectively). Lower airway parameters showed only common and specific environmental determination (PPW-TPP a2 = 0.24, e2 = 0.38; LPW-V c2 = 0.2, e2 = 0.63; PCV-AH c2 = 0.47, e2 = 0.28). The relationship between the maxilla and the hyoid bone (for variables PNS-AH, ANS-AH d2 = 0.9, 0.92, respectively) showed very strong additive genetic determination. The size of the soft palate was affected by additive and dominant genes. Its length (SPL) was strongly influenced by dominant genes, while its width (SPW) showed a moderate additive genetic influence. Owing to correlations in the behavior of variables, the data could be expressed in 5 principal components that jointly explained 36.8% of the total variance. CONCLUSIONS: The dimensions of the upper airway are strongly determined by genes, while the parameters of the lower airway depend mainly on environmental factors. TRIAL REGISTRATION: The protocol has been approved by the Kaunas Regional Ethical Committee (No. BE - 2-41., May 13, 2020).

The effects of weather on depressive symptoms in patients after cardiac surgery.

Patients with cardiovascular disease have depression more often than the general population does. The aim of the study was to detect the associations between the psychological state and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The prospective study was performed during 2008-2012 in Kaunas, Lithuania. The psychological state of 233 patients was assessed by using the Symptom Checklist-90-Revised instrument. The assessment was carried out at 1.5 months, 1 year, and 2 years after the surgery. A sample of 531 measurements of psychological states was used. To investigate the relationships between psychological scores and daily weather variables, a mixed linear model was used adjusting for sex, the type of surgery, age, the marital status, the presence of arterial hypertension, diabetes, major depressive disorders, dysthymic disorders, agoraphobia, smoking before surgery, and myocardial infarction in the anamnesis. The mean somatisation score and air temperature on the second day prior to the survey were found to have a negative correlation in the multivariate model. Lower mean scores of anxiety and depression were linked to hotter days (air temperature >16.25°C on the second day) that did not occur in July or August. During colder days (air temperature <0.35°C), a higher mean score of anxiety and phobic anxiety was observed. A higher mean score of somatizations, depression, and anxiety was seen on the second day after the day with wind speed ≤2.85 kt and on the day after the day with relative humidity <66%. Both a decrease and an increase in daily atmospheric pressure were associated with a higher depression score. Our results confirm that among patients after open heart surgery, psychosomatic complaints are related to some weather changes. The obtained results can help to determine the complexity of weather patterns linked to poorer psychological health.

Impact of temperature changes to the adhesion strength of molar tubes: an in vitro study.

BACKGROUND: The main purpose of this was to determine study adhesion strength of molar tubes bonding with a composite adhesive after exposure to a sudden change in temperature (thermal cycles). METHODS: The study sample consisted of 40 recently extracted human first permanent molars, which were randomly divided into two groups of 20: group 1 was the experimental group (affected by thermal cycles), and group 2 was the control group. Molar tubes were bonded with a light-cure tube adhesive. The experimental group teeth were dipped 2,000 times in saline at 5 °C and at 55 °C. The control group were immersed in 37 °C saline. Molar tubes for both groups were removed with an adapted Mecmesim Multitesters 2.5-I, and the data were recorded with EMPEROR software. ANOVA was used to calculate and compare the results. RESULTS: In the experimental group of the teeth, the maximum force was obtained at 94.2 N and the lowest force was 19.69 N. In the control group of the teeth, the maximum force was obtained at 159.1 N and the lowest force was 28.1 N. In the experimental group, the mean debonding force (59.12 N) was statically significantly smaller than in the control group (79.88 N), p = 0.0345. The forces in the control group were by 1.35 times greater than those in the experimental group. CONCLUSIONS: The forces of the adhesion of molar tubes to the tooth surface were reduced after exposure to a sudden change in temperature (thermal cycles). The results were significantly different between the experimental group and the control group.

Orthodontic canine substitution vs. implant-supported prosthetic replacement for maxillary permanent lateral incisor agenesis: A systematic review.

OBJECTIVE: The aim of this systematic review was to evaluate the results of two treatment methods: space opening for an implant and prosthetic replacement (PR) versus orthodontic space closure (SC) for maxillary lateral incisor agenesis (MLIA). MATERIAL AND METHODS: The protocol of the systematic review is in line with the PRISMA requirements. An electronic search was carried out on July 11, 2021 in Pubmed, ScienceDirect, Web of Science, and Plos One databases. The review included research articles published less than 10 years ago, written in English, involving both PR and SC methods in permanent dentition, and comparing and evaluating them. RESULTS: A total of 1,061 initially identified articles were found, full texts of 38 articles were read and assessed for eligibility, and 7 of them were included in this review. All of the articles evaluated the esthetics; in addition, 3 of them assessed periodontal health, 1 evaluated temporomandibular joint (TMJ) dysfunction, and 1 evaluated occlusion morphology disorders. One study of 7 found esthetics after SC to be statistically more pleasant, while the others found the results of both techniques to be equally esthetically satisfying. When comparing periodontal status between the groups, one study found gingival recession to be significantly more common in the SC group, while another article revealed that gingival recession and papillary defects were more common in the PR group. The remaining articles stated that there was no TMJ dysfunction, and differences in occlusion morphology disorders were not significant between the groups. CONCLUSION: The results of MLIA treatment with SC were more favorable esthetically, but the difference was not statistically significant. There is no statistically significant data related to periodontal health, and neither of the treatment methods caused TMJ or occlusion morphology disorders. If both methods are available, space closure is preferable, although high-quality clinical trials are needed to find more evidence.

Impact of Fluorosis on the Tensile Bond Strength of Metal Brackets and the Prevalence of Enamel Microcracks.

The objective of this in vitro study was to determine the effects of dental fluorosis on the tensile bond strength of metal brackets bonded to human teeth and to evaluate the changes in the tooth enamel surface after debonding. The study sample consisted of 68 recently extracted human upper premolars, which were divided into 2 groups: the fluorosis group (34 fluorosed teeth) and the control group (34 healthy teeth). Identical premolar metal brackets were bonded on the buccal surfaces of the teeth. Both groups were submitted to a tension test using a universal testing machine. The number and length of the enamel microcracks in the buccal surface of each tooth were determined before bracket bonding and after debonding using a stereomicroscope. The percentage adhesive remnant index (PARI) was calculated after debonding. The results showed that the tensile bond strength (TBS) of brackets bonded to fluorosed teeth was 21.08% lower than that of brackets bonded to healthy teeth (p < 0.0001). The length of the enamel microcracks on fluorosed teeth increased by 47.4% after debonding, whereas the control group showed an increase of only 12.6%. The PARI showed lower values for fluorosed teeth in comparison to the control group (p = 0.047). In conclusion, dental fluorosis has a negative impact on tensile bond strength and the length of microcracks formed after bracket debonding.

Relationship between unilateral posterior crossbite and mandibular asymmetry during late adolescence.

THE AIM OF THE STUDY: Was to evaluate the relationship of mandibular condylar and ramal symmetry with unilateral posterior crossbite during late adolescence. MATERIAL AND METHOD: 120 pre-orthodontic patients of the Lithuanian University of Health Sciences Department of Orthodontics were included in the study. The main inclusion criteria of the study group were the following: permanent dentition, age 15 to 18 years, unilateral crossbite. Panoramic radiographs database were analyzed, the following parameters were evaluated: mandibular condylar and ramal height, and asymmetry index according to Habets' technique. Statistical data analysis was performed using SPSS 22.0 statistical software. RESULTS: In the study group the mandibular condylar height, ramal height, and ramal plus condylar height on the crossbite side were statistically significantly lower than those on the noncrossbite side. Comparing the asymmetry indices between the study and the control groups, it was found all indices were statistically significantly higher in the group with unilateral posterior crossbite than those in the control group, p<0.001. CONCLUSION: Relationship between unilateral posterior crossbite and mandibular asymmetry during late adolescent was found, in subjects with unilateral posterior crossbite statistically significantly reduced mandibular condylar height and mandibular ramal height on the crossbite side was detected, they demonstrated a higher mandibular condylar and mandibular ramal asymmetry index, compared to the control group subjects, p<0.001.

Associations of short-term exposure to ambient air pollutants with emergency ambulance calls for the exacerbation of essential arterial hypertension.

We investigated the association between daily emergency ambulance calls (EAC) for elevated blood pressure that occurred during the time intervals of 8:00-13:59, 14:00-21:59, and 22:00-7:59, and exposure to CO, PM10, and ozone. We used Poisson regression to explore the association between the risk of EAC and short-term variation of pollutants, adjusting for seasonality and weather variables. Before noon, the risk was associated with an interquartile range (IQR) (7.9 µg/m3) increase in PM10 at lag 2-4 days below the median (RR = 1.08, p = 0.031) and with an IQR (0.146 mg/m3) increase in CO at lag 6-7 below the median (RR = 1.05, p = 0.028). During 14:00-21:59, the risk was associated with an IQR (18.8 µg/m3) increase in PM10 on the previous day below the median (RR = 1.04, p = 0.031). At night, EAC were negatively affected by lower O3 (lag 0-2) below the median (per IQR decrease RR = 1.10, p = 0.018) and a higher PM10 at lag 0-1 above the median for the elderly (RR = 1.07, p = 0.030).

The short-term associations of weather and air pollution with emergency ambulance calls for paroxysmal atrial fibrillation.

A circadian variation in the cardiovascular parameters has been detected. It is plausible that the influence of the environment varies during different periods of the day. We investigated the association between daily emergency ambulance calls (EC) for paroxysmal atrial fibrillation (AF) that occurred during the time intervals of 8:00-13:59, 14:00-21:59, and 22:00-7:59, and weather conditions and exposure to CO and PM10. We used Poisson regression to explore the association between the risk of EC for AF and environmental variables, adjusting for seasonal variation. Before noon, the risk was associated with an IQR (0.333 mg/m3) increase in CO at lag 2-6 days above the median (RR = 1.15, P = 0.002); a protective impact of CO on previous day was observed (RR = 0.91, P = 0.018). During 14:00-21:59, a negative effect of air temperature below 1.9 °C (lag 2-3 days) was detected (per 10 °C decrease: RR = 1.17, P = 0.044). At night, the elevated risk was associated with wind speed above the median (lag 2-4 days) (per 1-kt increase: RR = 1.07, P = 0.001) and with PM10 at lag 2-5 days below the median (per IQR (7.31 µg/m3) increase: RR = 1.21, P = 0.002). Individuals over 65 years of age were more sensitive to air pollution, especially at night (CO lag 2-3 days < median, per IQR (0.12 mg/m3) increase: RR = 1.14, P = 0.045; PM10 lag 2-5 days < median, per IQR increase: RR = 1.32, P = 0.001). The associations of air pollution and other environmental variables with acute events may be analyzed depending on the time of the event.

The effect of the teeth bleaching with 35% hydrogen peroxide on the tensile bond strength of metal brackets.

The objective of this study was to determine the effects of teeth bleaching on the tensile bond strength of metal brackets bonded with light-curing adhesive system to the human enamel. 40 recently extracted human permanent molars were used for the study. The mesial buccal surface of each tooth was used as a control group and the distal buccal surface was used as an experimental group. Control group surfaces were not submitted to bleaching, while experimental group surfaces were bleached with in-office bleaching material containing 35% hydrogen peroxide. 30 days after the bleaching, identical premolar metal brackets were bonded to each surface using light-curing adhesive. Both groups were submitted to a tension test, using a universal machine. The tensile bond strength of brackets bonded to the bleached enamel was 15% lower than that of brackets bonded to the unbleached enamel. After debonding, more adhesive was left on the bracket base in experimental group than in the control group. The conclusion of this study was that bleaching with an in-office bleaching material containing 35% hydrogen peroxide reduced the tensile bond strength of orthodontic bracket adhesive to the enamel surface.

Relationship between malocclusion, soft tissue profile, and pharyngeal airways: A cephalometric study.

BACKGROUND AND OBJECTIVE: The recent years have been marked by a search for new interrelations between the respiratory function and the risk of the development of malocclusions, and algorithms of early diagnostics and treatment have been developed. The aim of the study was to evaluate the relationships between hard and soft tissues and upper airway morphology in patients with normal sagittal occlusion and Angle Class II malocclusion according to gender. MATERIALS AND METHODS: After the evaluation of clinical and radiological data, 114 pre-orthodontic patients with normal or increased ANB angle, were randomly selected for the study. The cephalometric analysis was done by using the Dolphin Imaging 11.8 computer software. RESULTS: Comparison of the cephalometric values of soft tissue and airway measurements performed statistically significant negative correlation between the width of the upper pharynx and the ANB angle was found: the ANB angle was decreasing with an increasing width of the upper pharynx. The airways showed a statistically significant negative correlation between the width of the lower pharynx and the distance from the upper and the lower lips to the E line. Logistic regression analysis was performed to evaluate significant factors that could predict airway constriction. The upper pharynx was influenced by the following risk factors: a decrease in the SNB angle, an increase in the nose tip angle, and younger age; while the lower pharynx was influenced by an increase in the distance between the upper lip and the E line and by an increase in the upper lip thickness. CONCLUSIONS: During critical period of growth and development of the maxillofacial system, the patients with oral functional disturbances should be monitored and treated by a multidisciplinary team consisting of a dentist, an orthodontist, a pediatrician, an ENT specialist, and an allergologist. Cephalometric analysis applied in our study showed that Angle Class II patients with significantly decreased facial convexity angle, increased nasomental, upper lip-chin, and lower lip-chin angles, and upper and lower lips located more proximally to the E line more frequently had constricted airways.

Prevention and treatment of white spot lesions during and after fixed orthodontic treatment: A systematic literature review.

OBJECTIVE: The aim of the study is to evaluate the effectiveness of fluoride and casein topical preparations in the prevention of white spot lesions during and after fixed orthodontic treatment. MATERIAL AND METHODS: Information search for controlled studies on humans published in the English language between 2008 and 2013 was conducted in Medline via PubMed, ScienceDirect, and Oxford University Press: Oxford journals and The Cochrane Library, as well as the Web search Google Scholar. 177 articles were reviewed; eleven clinical studies fulfilled all inclusion criteria. RESULTS: In the clinical studies it was concluded that high-concentration fluoride supplements are effective in reducing white spot lesions. Results of the studies showed the same usefulness of fluoride varnish, MI Paste, and usual oral hygiene using 1100 ppm of fluoride toothpaste. Effect on the prevention and treatment of white spot lesions of oral hygiene with toothpaste containing 1450 ppm of fluoride in orthodontic patients was evaluated. The positive effect of casein phosphopeptide-amorphous calcium phosphate in white spot lesions treatment was found. Otherwise in some clinical studies use of casein derivates during fixed orthodontics for white spot lesions treatment was not effective. CONCLUSIONS: More clinical studies conducted during last five years yielded significantly positive results about the effectiveness of fluoride and caseine supplements in ameliorating white spot lesions during and after fixed orthodontic treatment. For a higher-risk patient group, additional supplements such as high-concentrated fluoride varnish, chewing sticks, or casein derivates, are required. A good oral hygiene regimen using high-fluoride toothpaste is as effective as fluoride or casein derivates in the prevention of new white spot lesions formation.

Vertical and sagittal morphology of the facial skeleton and the pharyngeal airway.

AIM: The aim of this study was to evaluate the relationship between sagittal and vertical facial skeletal morphology, and the morphology of the upper and lower pharyngeal airway. MATERIAL AND METHODS: Pharyngeal airway structures were studied in 101 healthy children (36 boys and 65 girls) aged 7-17 years who were referred for orthodontic treatment. The sample was divided into two groups: according size of the ANB angle group Class I: angle till 4º was considered as skeletal Angle Class I; group Class II: ANB angle more than 4º, considered as skeletal Angle Class II. The vertical pattern was classified using the SN-MP angle, with angle less than 34 taken as normal, and more than 34 - as high vertical growth patterns. The linear measurements and angles were calculated using special purpose software (Dolphin v. 11.0). Pharyngeal width was measured at different point levels using Arnett/Gunson airway analysis. RESULTS: A statistically significant difference between the two groups, and airway width on all levels was statistically significantly narrower in Angle Class II. Pearson's correlation coefficient showed a negative statistically significant dependence between nasopharyngeal airway, oropharyngeal airway space, and SN-MP angle. CONCLUSION: Statistically significantly narrower airways were found in patients with ANB more than 4°. In groups divided by SN-MP angle statistically significant difference have not found. Nasopharyngeal airway and oropharyngeal airway spaces statistically significantly negatively correlated with the SN-MP angle: the bigger the SN-MP angle, the smaller were nasopharyngeal and oropharyngeal airway spaces.

Age and gender influence on oral hygiene among adolescents with fixed orthodontic appliances.

BACKGROUND: Many factors can influence oral health including oral hygiene measures, eating habits, attention from parents, education and the social situation. It is even harder to keep good oral health when orthodontic treatments are applied, because orthodontic treatments are usually undergone by children and adolescents who have fewer skills and pay less attention to their oral health; this may lead to bleeding on probing (BOP), a higher plaque index (PI), a higher gingival index (GI), and an increase in probing pocket depth (PPD). The aim of this study was to compare the features of oral hygiene among different age groups and gender in patients with fixed orthodontic appliances. MATERIAL AND METHODS: The study consisted of 107 patients from the Department of Orthodontics of Lithuanian University of Health Sciences aged 12 to 18 years with fixed orthodontic appliances. The patients were given a questionnaire with 17 questions about their oral hygiene and how it changed after they started their treatment with fixed orthodontic appliances. A statistical analysis was performed using the IBM SPSS Statistics 22.0. RESULTS: Among the 107 participants, 69 (64.5%) were females and 38 (35.5%) were males. 57 (53.3%) participants were 12 to 15 years old and 50 (46.7%) 16 to 18 years old. There was a statistically significant result when comparing the differences between females and males: females brushed their teeth more regularly than males (p<0.005). Statistically significant results could also be observed when comparing the different age groups: 16 to 18 year old patients reported more often brushing their teeth three or more times a day (p<0.005), reported more intensive changes in their oral hygiene after starting orthodontic treatments (p<0.005), and received more recommendations from their orthodontist about oral hygiene measures (p<0.005). CONCLUSION: In patients with fixed orthodontic appliances, the oral hygiene of 16 to 18 year old adolescents is better than the oral hygiene of 12 to 15 year old adolescents. Females brush their teeth more regularly than males. More studies should be done to evaluate any differences.

Prevention and Treatment of White Spot Lesions During and After Treatment with Fixed Orthodontic Appliances: a Systematic Literature Review.

OBJECTIVES: The aim of the systematic literature review is to update the evidence for the prevention of white spot lesions, using materials containing fluoride and/or casein phosphopeptide-amorphous calcium phosphate during and after treatment with fixed orthodontic appliances. MATERIAL AND METHODS: Information search for controlled studies on humans published between January 2008 and February 2016 was performed in PubMed, ScienceDirect, Embase, The Cochrane Library. Inclusion criteria were: the English language, study on humans, patients undergoing orthodontic treatment with fixed appliances, randomized or quasi-randomized controlled clinical studies fluoride-containing product or casein derivates used throughout the appliance therapy or straightaway after debonding. RESULTS: 326 articles were reviewed (Embase 141, PubMed 129, ScienceDirect 41, Cochrane 15). Twelve clinical studies fulfilled all inclusion criteria. Use of fluoridated toothpaste had a remineralizing effect on white spot lesions (WSLs) (P < 0.05); fluoride varnish and casein supplements were effective in prevention and early treatment of WSLs (P < 0.05). CONCLUSIONS: Early detection of white spot lesions during orthodontic treatment would allow implementing preventive measures to control the demineralization process before lesions progress. The systemic review has showed that the usage of fluoride and casein supplements in ameliorating white spot lesions during and after fixed orthodontic treatment is significantly effective. However the use of casein phosphopeptide-amorphous calcium phosphate can be more beneficial than fluoride rinse in the reduction of demineralization spots.

Lateral teleradiography of the head as a diagnostic tool used to predict obstructive sleep apnea.

OBJECTIVES: To (1) assess the relationship between obstructive sleep apnea (OSA) and craniofacial, pharyngeal anatomy and (2) to submit the recommendations for clinicians for increasing the sensitivity in the diagnostics of OSA. METHODS: A review of the relevant literature linking OSA in adults with cephalometric analysis was performed. In total, 11 articles with similar procedural criteria were selected. The data were analysed using the Comprehensive Meta-Analysis Software (Biostat Inc., Englewood, NJ) and Statistica 12.0 (StatSoft Inc., Dell Software, Tulsa, OK). RESULTS: Adults with OSA did not show statistically significant differences in the sagittal and vertical skeletal planes in comparison with the controls (p > 0.05). The patients with OSA had soft palate length, width and area increased accordingly by 4.21, 1.99 mm and 0.86 cm(2), tongue area increased by 2.02 cm(2), the upper posterior pharyngeal space (SPAS) and lower posterior pharyngeal space reduced accordingly by 4.53 and 1.32 mm, mandibular plane to the hyoid bone (MP-H) distance increased by 4.14 mm compared with the controls (p < 0.05). The SPAS parameter of the patients with OSA did not show statistically significant differences between the studies, with the mean value being 5.69 mm. CONCLUSIONS: Analysed cephalometric data totally supported the concept of soft-tissue abnormalities in subjects with OSA, skeletal-only halfway; MP-H and SPAS being the most reliable parameters. Increased MP-H may serve as a predictor when differentiating normal subjects and patients with OSA. Reduced SPAS width could be a prognostic parameter for suspecting OSA. These two values should be kept in mind by dentists and can also be used as a simple auxiliary method by physicians; nevertheless, it is still underestimated and more studies are needed.

Relationships between Malocclusion, Body Posture, and Nasopharyngeal Pathology in Pre-Orthodontic Children.

BACKGROUND: Malocclusion, body posture, and breathing pattern may be correlated, but this issue is still controversial. The aim of the study was to examine the relationship between the type of malocclusion, body posture, and nasopharyngeal obstruction in children aged 7-14 years. MATERIAL AND METHODS: The study group comprised 94 patients aged 7-14 years (mean±SD: 11.9±2.1 years); 44 (46.8%) males and 50 (53.2%) females. All patients passed an examination performed by the same orthodontist (study model and cephalometric radiograph analysis), orthopedic surgeon (body posture examined from the front, side, and back), and otorhinolaryngologist (anterior and posterior rhinoscopy and pharyngoscopy) in a blind manner. RESULTS: Postural disorders were observed in 72 (76.6%) patients. Hypertrophy of the adenoids was diagnosed in 54 (57.4%) patients, hypertrophy of the tonsils in 85 (90.3%), nasal septum deviation in 51 (54.3%), and allergic rhinitis in 19 (20.2%) patients. There was a statistically significant correlation between presence of kyphotic posture and a reduction in the SNB angle, representing sagittal position of the mandible. Also, there was a statistically significant association between kyphotic posture and nasopharyngeal obstruction (54.1% of patients with nasopharyngeal obstruction were kyphotic, compared with 25% of patients with no nasopharyngeal obstruction; p=0.02). Kyphotic posture and reduced SNB angle were more common among males. CONCLUSIONS: We concluded that: 1) there was a significant association between the sagittal position of the mandible (SNB angle) and a kyphotic posture; 2) kyphotic posture was significantly more common among patients with nasopharyngeal obstruction.